Patterns of lymphatic metastases in upper tract urothelial carcinoma: Experience from three comprehensive cancer centers.

349 Background: Data on patterns of lymph node metastasis (LNM) for upper tract urothelial carcinoma (UTUC) is sparse despite its critical relevance for staging and therapeutic potential, with only 1 prior study detailing patterns of spread in 23 pathologically confirmed cases (Kondo T et al, Urol. 2007). Methods: We retrospectively identified and reviewed patients with pTany N+ M0 UTUC at 3 comprehensive cancer centers which routinely perform template-based dissections for UTUC. Anatomic locations of the primary tumor and positive lymph nodes based on the pathological specimens were analyzed, and maps of the location and incidence of LNM constructed. Results: A total of 92 patients with pN+ UTUC were identified, 63 of whom had renal pelvis (n=43) or proximal ureteral (n=20) tumors. LNM from left renal pelvis tumors occurred to the hilar (29.4%), pre- and para-aortic (50.0%) regions, with secondary spread to suprarenal (1.8%), interaortocaval (5.9%), and common iliac (2.9%) regions. LNM from right renal pelvic tumors occurred to the hilar (24.1%), pre- and para-caval (38.0%), retrocaval (13.8%), and inter-aortocaval (24.1%) areas. Left proximal ureteral tumors primarily had LNM to the hilar (46.1%), para-aortic (46.1%), and retro-aortic (7.7%) regions. Right proximal ureteral tumors had LNM to the hilar (36.4%), paracaval (54.5%), and retrocaval (9.1%) regions. A significant difference in survival was noted with patients who had organ confined tumor (p = 0.002) and a lymph node density of less than 25% (p = 0.005). The 1, 2, and 5-year cancer-specific survival rates of the overall cohort were 69%, 49%, and 27%, respectively. Conclusions: Our multi-institutional study provides data regarding the primary landing zones for LNM in renal pelvis and proximal ureter UTUC as well as guidance for developing anatomic dissection templates for prospective studies in UTUC incorporating surgical methodologies as a variable.

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Who will benefit most from lymph node dissection in invasive upper tract urothelial carcinoma: a matched case-control study

10.21203/rs.3.rs-81357/v1 ◽

2020 ◽

Author(s):

Zaishang Li ◽

Xueying Li ◽

Ying Liu ◽

Kefeng Xiao

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Lymph Node Dissection ◽

Propensity Score Analysis ◽

Upper Tract Urothelial Carcinoma ◽

Node Dissection ◽

Metastatic Tumors ◽

Tumor Patients ◽

Upper Tract ◽

Significant Difference

Abstract Background: Limited or regional lymphadenectomy (lymph node dissection, LND), which can help in postoperative risk stratification, is performed with radical nephroureterectomy (RNU). However, the specific ones are appropriate for LND in upper tract urothelial carcinoma (UTUC) has long been debated. We determined the clinical value of LND in different groups of UTUC patients who underwent RNU and someone who benefit most from LND in this study.Methods: Patients diagnosed with UTUC between 2004 and 2015 with available TNM stage classification were identified from 18 Surveillance, Epidemiology and End Results (SEER) registries. Propensity score analysis was used to match the baseline differences of patients. Results: This study included 5426 patients, and 2000 patients with invasive UTUC were matched (1000 patients with LND vs. 1000 patients without LND). The 5-year cancer-specific survival (CSS) estimate for the total cohort was 73.5%. After matching, the LND group had a higher 5-year CSS rate than the no-LND group (77.2% vs. 70.1%, P = 0.002). In heterogeneity analysis, there were significant differences between LND groups and no-LND in stage T4 (52.5% vs. 23.3%, P< 0.001), lymph node metastatic tumors (48.0% vs. 21.2%, P=0.015) and non-distant metastatic tumors (78.5% vs. 71.5%, P = 0.002). According to the most recent pathological prognostic groups classification, significant differences in survival were found between groups only with stage IV tumors (52.0% vs. 25.1%, P< 0.001). However, only stage T4NxM0 tumor patients were found a significant difference between LND groups in subgroup analysis (57.4% vs. 29.9%, P< 0.001). Conclusions:LND may improve the survival of invasive UTUC patients who undergo RNU, especially in T4NxM0 tumor patients. However, this hypothesis requires further confirmation.

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Trends in management and outcomes in patients with upper tract urothelial carcinoma following radical nephrouretectomy at Memorial Sloan Kettering Cancer Center.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.469 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 469-469

Author(s):

Nathan Colin Wong ◽

Melissa Assel ◽

Andrew Tracey ◽

Ricardo Alvim ◽

Nima Almassi ◽

...

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Generalized Additive Models ◽

Additive Models ◽

Upper Tract Urothelial Carcinoma ◽

Oncologic Outcomes ◽

Cancer Center ◽

Cancer Specific Survival ◽

Upper Tract ◽

The Past

469 Background: Although there have been changes in the treatment paradigm of patients with upper tract urothelial carcinoma (UTUC) over the past 2 decades, there is limited data on the particular management strategies and associated outcomes. We evaluated surgical trends, perioperative management, and oncologic outcomes of patients who underwent radical nephroureterectomy (RNU) for UTUC at Memorial Sloan Kettering Cancer Center over a 24-year period. Methods: Between 1995 and 2018, we identified 760 patients with UTUC who underwent RNU. 15 had multiple RNU and we kept only the first procedure for analysis. Generalized additive models were fitted to examine the association between date of surgery and continuous while generalized additive models with a logit link were used to estimate categorical variables. As surgical approach was defined using three different categories (open, laparoscopic and robotic) a generalized additive multinomial model was used. Generalized additive cox proportional hazards models were used to estimate the association between surgery date and estimate 2-year cancer-specific survival. Results: The use of pre-operative diagnostic endoscopic biopsies also increased from 12% to 72% which coincides with an increased proportion high grade disease on final pathology from 55% to 91%. The rate of open RNU declined from 100% to 54% with a coinciding rise in the utilization of minimally invasive approaches. Laparoscopy peaked in 2008 and then was subsequently replaced by the robotic approach. Mean lymph node yield increased over the study interval with more retroperitoneal lymph node dissections performed. Utilization of neoadjuvant chemotherapy also increased over time with a current rate of 31%, coinciding with an increase in pT0 rate from only 2% to 9%.The 2-year cancer specific survival probability has improved from 76% to 87% over the study period. Conclusions: Several changes in treatment patterns for patients with UTUC over the past 2 decades appear to correspond with an improvement of oncologic outcomes. How these changes directly relate to each other requires further investigation.

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